Click here for application in Word format or complete and print the application below. Send the completed application and check or payment to:

Sandra Gilbert, National Women In Pensions, Inc.
c/o Southern Company
30 Ivan Allen Jr. Blvd. NW
Bin SC1101
Atlanta, GA 30308

Fax: (404) 506-0730

Email: slgilber@southernco.com

New Member or

Renewal Member


Name


Company


Title(s)


Business Address


Work Phone


Work Fax


Work Email


Mobile


Home Address (for internal records only - this information will not be given out without your permission)


Home Phone


Home Fax


Home Email

Where would you prefer your mail:

Work Home

Please tell us your line of business (what do you do in the industry - plan sponsor, investments, plan administration, marketing, service provider, attorney, benefit consultant, communications, actuary, market research, etc.)

I understand that to be accepted into membership, I must be at least 21 years of age, be female, and have some work experience in a field related to employee benefit plans. By signing below, I apply for membership and acknowledge that I satisfy the criteria for membership

Signature_______________________________________ Date_________

Enclosed is my check for dues in the amount of $40 payable to:

NATIONAL WOMEN IN PENSIONS, INC.

Charge my

Credit Card Number

Expiration Date



Signature_______________________________________________________